Certificate Number     37514
                                              ----------

                               STATE OF ILLINOIS

                                   OFFICE OF
                            THE SECRETARY OF STATE

                                    [LOGO]

     TO ALL WHOM THESE PRESENTS SHALL COME GREETING: WHEREAS, Articles of 
Incorporation duly signed and verified of WEST SUBURBAN KIDNEY CENTER, S.C.
have been filed in the Office of the Secretary of State on the 31st day of March
A.D. 1969, as provided by "THE BUSINESS CORPORATION ACT" of Illinois, in force 
July 13, A.D. 1933.

Now Therefore, I, PAUL POWELL, Secretary of State of the State of Illinois, by
virtue of the powers vested in me by law, do hereby issue this certificate of
incorporation and attach thereto a copy of the Articles of Incorporation of the
aforesaid corporation.

          IN TESTIMONY WHEREOF, I hereto set my hand and cause to be affixed the
Great Seal of the State of Illinois, Done at the City of Springfield this 31st
day of March A.D. 1969 and of the Independence of the United States the one
hundred and 93rd.


                                             /s/ Paul Powell
                                             --------------------------------
                                                       SECRETARY OF STATE

[SEAL]

 

                                 FORM B C A 17

      BEFORE ATTEMPTING TO EXECUTE THESE BLANKS BE SURE TO READ CAREFULLY
                     THE INSTRUCTIONS ON THE BACK THEREOF

                  [THESE ARTICLES MUST BE FILED IN DUPLICATE]

                                                    ----------------------------
                                                    (Do not write in this space)


  STATE OF ILLINOIS   }                             Date Paid  3-31-69
                      }  ss.                        Initial License Fee $    .60
    COOK COUNTY       }                             Franchise Tax       $ 133.34
                                                    Filing Fee          $  75.00
TO PAUL POWELL, Secretary of State:                 Clerk  [SIGNATURE ILLEGIBLE]
                                                    ----------------------------

  The undersigned,
  
  ------------------------------------------------------------------------------
                                                        Address
     Name                     Number         Street      City     State
  ------------------------------------------------------------------------------

  Robert C. Muehrcke    c/o West Suburban Hospital 518 N, Austin, Oak Park, Ill.
  ------------------------------------------------------------------------------
  Arthur Gene Lawrence  c/o West Suburban Hospital 518 N, Austin, Oak Park, Ill.
  ------------------------------------------------------------------------------
  Joseph B. Moles       c/o West Suburban Hospital 518 N, Austin, Oak Park, Ill.
  ------------------------------------------------------------------------------

  being one or more natural persons of the age of twenty-one years or more or a
  corporation, and having subscribed to shares of the corporation to be
  organized pursuant hereto, for the purpose of forming a corporation under "The
  Business Corporation Act" of the State of Illinois, do hereby adopt the
  following Articles of Incorporation:

                                  ARTICLE ONE

  The name of the corporation hereby incorporated is: WEST SUBURBAN KIDNEY 
  CENTER, S.C.

                                  ARTICLE TWO

  The address of its initial registered office in the State of Illinois is:
  Suite 711, 209 S. LaSalle Street in the City of Chicago, (80604), County of
  -------------------------               ----    -------   -----        
                                                          (Zip Code)
  Cook and the name of its initial Registered Agent at said address is: Jerry M.
  ----                                                                  --------
  Reinsdorf
  ---------   

                                 ARTICLE THREE

  The duration of the corporation is: perpetual
                                      -----------------------------------------

 
                                 ARTICLE FOUR

THE PURPOSE OR PURPOSES FOR WHICH THE CORPORATION IS ORGANIZED ARE:

     Medical Corporation: To own, operate and maintain an establishment for the 
study, diagnosis and treatment of human ailments and injuries, whether physical 
or mental, and to promote medical, surgical and scientific research and 
knowledge: provided that medical or surgical treatment, consultation or advice 
may be given by employees of the corporation only if there are licensed pursuant
to the Medical Practice Act.


                                 ARTICLE FIVE

Paragraph 1: The aggregate number of shares which the corporation is authorized 
to issue 10,000 divided into 3 (three) classes. The designation of each class, 
         ------              ---------
the number of shares of each class, and the par value, if any, of the shares of 
each class, or a statement that the shares of any class are without par value, 
are as follows:

 
    Series     Number of   Par value per share or statement that shares
   Class    (If any)     Shares               are without par value
                            
   common                10,000                      $1.00    
 

Paragraph 2: The preferences, qualifications, limitations, restrictions and the 
special or relative rights in respect of the shares of each class are:

                                     NONE

 
                                 ARTICLE SIX

     The class and number of shares which the corporation proposes to issue 
without further report to the Secretary of State, and the consideration 
(expressed in dollars) to be received by the corporation therefor, are:

 
 
                                                      Total consideration to be
          Class of shares     Number of shares          received therefor:
                                                 
            common                 1,200                 $  1,200 
                                                         $
 


                                 ARTICLE SEVEN

     The corporation will not commence business until at least one thousand 
dollars has been received as consideration for the issuance of shares.

                                 ARTICLE EIGHT

     The number of directors to be elected at the first meeting of the 
shareholders is: three
                -------   

                                 ARTICLE NINE

Paragraph 1: It is estimated that the value of all property to be owned by the 
corporation for the following year wherever located will be $__________

Paragraph 2: It is estimated that the value of the property to be located within
the State of Illinois during the following  year will be $____________ 

Paragraph 3: It is estimated that the gross amount of business which will be 
transacted by the corporation during the following year will be $__________
                                                                
Paragraph 4: It is estimated that the gross amount of business which will be 
transacted at or from places of business in the State of Illinois during the 
following year will be $___________ . The corporation elects to pay the initial 
franchise tax on the basis of its entire stated capital of the corporation.

     NOTE: If all the property of the corporation is to be located in this State
and all of its business is to be transacted at or from places of business in 
this State, or if the incorporators elect to pay the initial franchise tax on
the basis of its entire stated capital and paid-in surplus, then the information
called for in Article Nine need not be stated.


 
                              [SIGNATURE ILLEGIBLE]
                              ----------------------------------
                              __________________________________
                              [SIGNATURE ILLEGIBLE]
                              ----------------------------------
                              __________________________________}  Incorporators
                              [SIGNATURE ILLEGIBLE]
                              ----------------------------------
                              __________________________________
                              __________________________________

     NOTE: There may be one or more incorporators. Each incorporator shall be 
either a corporation, domestic or foreign, or a natural person of the age of 
twenty-one years or more. If a corporation acts as incorporator, the name of the
corporation and state of incorporation shall be shown and the execution must be 
by its President or Vice-President and verified by him, and the corporate seal 
shall be affixed and attested by its Secretary or an Assistant Secretary.


                           OATH AND ACKNOWLEDGMENT

STATE OF ILLINOIS ) ss.
COOK County       )

     [SIGNATURE ILLEGIBLE]. A Notary Public, do hereby certify that on the 28th 
day of March 1969 Robert C. Muehrcke, Arthur Gene Lawrence and Joseph B. Moles 
personally appeared before me and being first duly sworn by me acknowledged the 
signing of the foregoing document in the respective capacities therein set forth
and declared that the statements therein contained are true.

     IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year 
above written.


     Place                                        [SIGNATURE ILLEGIBLE]
                                             ----------------------------------
(NOTARIAL SEAL)                                         Notary Public
     Here


                                 FORM B C A-17
================================================================================

                           ARTICLES OF INCORPORATION

                       WEST SUBURBAN KIDNEY CENTER, S.C.

================================================================================

The following fees are required to be paid at the time of issuing certificate of
incorporation: Filing fee, $75.00: Initial license fee of 50c per $1,000.00 or
1/20th of 1% of the amount of stated capital and paid-in surplus the corporation
proposes to issue without further report Article Six: Initial franchise tax of
1/10th of 1% of the issued, as above noted. However, the minimum initial
franchise tax is $100.00 and varies monthly on $100.000, or lees, as follows:
January, $150.00: February, ???, March, $133.33: April, $125.00: May, $116.67,
June, ???: July, $100.00: August, $91.47: September, $83.34: October, $75.00:
November, $66.67: December, $54.34. (See Ser. 133 BCA).

In excess of $100.000 the franchise tax per $1,000.00 is as follows: Jan, $1.50:
Feb, 1.4167: March, 1.3334: April, 1.25, May, 1.1667: June, 1.0834: July, $1.00:
Aug, .9167: Sept, .8334: Oct. .75, Nov. 6667: Dec. 5834. All shares issued in
excess of the amount mentioned in Article Six of this application must be
reported within 60 days from date of issuance thereof and franchise tax and
license fee paid thereon: otherwise, the corporation is subject to a penalty of
1% for each month on the amount until reported and subject to a time of not to
exceed $500.00.

The same fees are required for a subsequent issue of shares except the filing 
fee is $1.00 instead of $75.00.



                                                       [SIGNATURE ILLEGIBLE]
================================================================================
                                                         Secretary of State

 
                            File Number      4947-719-8
                                        ---------------

                               STATE OF ILLINOIS

                                   OFFICE OF
                            THE SECRETARY OF STATE

                                    [LOGO]

     WHEREAS, ARTICLES OF AMENDMENT TO THE ARTICLES OF INCORPORATION OF WEST
SUBURBAN KIDNEY CENTER, S.C. INCORPORATED UNDER THE LAWS OF THE STATE OF
ILLINOIS HAVE BEEN FILED IN THE OFFICE OF THE SECRETARY OF STATE AS PROVIDED BY
THE BUSINESS CORPORATION ACT OF ILLINOIS, IN FORCE JULY 1, A.D. 1984.

Now Therefore, I, George H. Ryan, Secretary of State of the State of Illinois,
by virtue of the powers vested in me by law, do hereby issue this certificate
and attach hereto a copy of the Application of the aforesaid corporation.

     IN TESTIMONY WHEREOF, I hereto set my hand and cause to be affixed the
Great Seal of the State of Illinois, at the City of Springfield, this 27TH day
of FEBRUARY A.D. 1992 and of the Independence of the United States the two
hundred and 16TH.


                                                  /s/ George H. Ryan
                                                  ------------------------------
                                                            SECRETARY OF STATE

[SEAL]

 
Form BCA-10.30         ARTICLES OF AMENDMENT 

(Rev. Jan. 1991)                                        File # 4947-719-8
- --------------------------------------------------------------------------------

George H. Ryan                                           SUBMIT IN DUPLICATE
Secretary of State                                 
Department of Business Services                      ---------------------------
Springfield, IL 62756                     
Telephone (217) 782-6961                                This space for use by
                                                          Secretary of State
- ------------------------------------                 Date  2-27-92

                                                     Franchise Tax     $
                                                     Filing Fee        $ 25
remit payment in check or money                      Penalty           $
order, payable to "Secretary of State"

                                                     Approved:
- --------------------------------------------------------------------------------

1.  CORPORATE NAME:  West Suburban Kidney Center, S.C
                   -------------------------------------------------------------
                                                                     (Note 1)

2.  MANNER OF ADOPTION:

          The following amendment of the Articles of Incorporation was adopted
          on February 20, 1992 in the manner indicated below. ("X" one box only)

    [_]   By a majority of the incorporators, provided no directors were named
          in the articles of incorporation and no directors have been elected;
          or by a majority of the board of directors, in accordance with Section
          10.10, the corporation having issued no shares as of the time of
          adoption of this amendment;
                                                                     (Note 2)

     [_]  By a majority of the board of directors, in accordance with Section
          10.15, shares having been issued by shareholder action not being
          required for the adoption of the amendment;
                                                                     (Note 3)

     [_]  By the shareholders, in accordance with Section 10.20, a resolution of
          the board of directors having been duly adopted and submitted to the
          shareholders. At a meeting of shareholders, not less than the minimum
          number of votes required by statute and by the articles of
          incorporation were voted in favor of the amendment;
                                                                     (Note 4)

     [_]  By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          shareholders having not less than the minimum number of votes required
          by statute and by the articles of incorporation. Shareholders who have
          not consented in writing have been given notice in accordance with
          Section 7.10;

                                                                     (Note 4)

     [X]  By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          all the shareholders entitled to vote on this amendment;
                                                                     (Note 4)

                              (INSERT AMENDMENT)

(Any article being amended is required to be set forth in its entirety.) 
(Suggested language for an amendment to change the corporate name is RESOLVED, 
that the Articles of Incorporation be amended to read as follows:)

- --------------------------------------------------------------------------------
                                  (NEW NAME)

                All changes other than name, include on page 2
                                    (over)

 
                                  Resolution


     RESOLVED, that paragraphs 1 and 2 of Article V of the Articles of
Incorporation of this corporation are hereby changed and amended to read as
follows:

PARAGRAPH 1: The aggregate number of shares which the corporation is authorized 
to issue is 10,010,000 divided into two (2) classes. The designation of each 
class, the number of shares of each class, and the par value, if any, of the 
shares of each class, or a statement that the shares of any class are without 
par value, are as follows:

 
 
                                                   PAR VALUE PER SHARE OR
                SERIES        NUMBER               STATEMENT THAT SHARES
CLASS          (if any)     OF SHARES              ARE WITHOUT PAR VALUE
- -----          --------     ---------              ----------------------
                                           
COMMON           NONE          10,000              $1.00 par value per share

CLASS A          NONE      10,000,000              $1.00 par value per share
PREFERRED
 

PARAGRAPH 2: The preference, qualification, limitations, restrictions, and the 
special or relative rights in respect to the shares of each class are:

The stated capital of the Corporation shall be at least equal to the sum of the 
aggregate par value of all issued shares having par value, plus such amounts as 
from time to time by resolution of the Board of Directors may be transferred 
thereto.

Upon dissolution, whether voluntary or involuntary, or upon the insolvency,
liquidation or distribution of the assets of the Corporation, the holders of the
Class A Preferred Stock shall be first entitled to receive out of the net assets
of the Corporation, the par value of $1.00 per share. All of the other assets if
there are any, shall be distributed among the holders of shares of the Common
Stock.

Class A Preferred Stock of the Corporation shall be non-voting at all times.

 
3.   The manner in which any exchange, reclassification or cancellation of
     issued shares, or a reduction of the number of authorized shares of any
     class below the number of issued shares of that class, provided for or
     effected by this amendment, is as follows: (if not applicable, insert "No
     change")

     No Change

4.   (a) The manner in which said amendment effects a change in the amount of
     paid-in capital (Paid-in capital replaces the terms Stated Capital and 
     Paid-in Surplus and is equal to the total of these accounts) is as follows:
     (if not applicable, insert "No change")

     No Change

     (b) The amount of paid-in capital (Paid-in Capital replaces the terms 
     Stated Capital and Paid-in Surplus and is equal to the total of these
     accounts) as changed by this amendment is as follows: (If not applicable,
     insert "No change")

     No Change


                                              Before Amendment  After Amendment
                        Paid-in Capital       $_______________  $______________

                      (Complete either Item 5 or 6 below)

5.   The undersigned corporation has caused this statement to be signed by its
     duly authorized officers, each of whom affirms, under penalties of perjury,
     that the facts stated herein are true.

     Dated          2/20              1992     West Suburban Kidney Center, S.C.
           --------------------------,  --    ---------------------------------
                                                   (Exact Name of Corporation)
                                             
     attested by /s/ Paul Balter               by /s/ Arthur Morris
                ---------------------------      -------------------------------
                (Signature of Secretary or         (Signature of President or
                 Assistant Secretary)              Vice President)
                                             
                Paul Balter, Secretary         Arthur Morris, President
               ----------------------------    ---------------------------------
               (Type or Print Name and Title)   (Type or Print Name and Title)

6.   If amendment is authorized by the incorporators, the incorporators must 
     sign below.

                                      OR

     If amendment is authorized by the directors and there are no officers, then
     a majority of the directors or such directors as may be designated by the
     board, must sign below.

     The undersigned affirms, under the penalties of perjury, that the facts 
     stated herein are true.

     Dated_______________________, 19__

     __________________________________     ____________________________________

     __________________________________     ____________________________________

     __________________________________     ____________________________________

     __________________________________     ____________________________________
   

 
                            NOTES and INSTRUCTIONS

NOTE 1:   State the true exact corporate name as it appears on the records of
          the office of the Secretary of State, BEFORE any amendments herein
          reported.

NOTE 2:   Incorporators are permitted to adopt amendments ONLY before any shares
          have been issued and before any directors have been named or elected.
          ((S) 10.10)

NOTE 3:   Directors may adopt amendments without shareholder approval in only
          six instances, as follows:

          (a)  to remove the names and addresses of directors named in the 
               articles of incorporation;

          (b)  to remove the name and address of the initial registered agent
               and registered office, provided a statement pursuant to (S) 5.10
               is also filed;

          (c)  to split the issued whole shares and unissued authorized shares
               by multiplying them by a whole number, so long as no class or
               series is adversely affected thereby;

          (d)  to change the corporate name by substituting the word
               "corporation", "incorporated", "company", "limited", or the
               abbreviation "corp.", "inc.", "co.", or "ltd." for a similar word
               or abbreviation in the name, or by adding a geographical
               attribution to the name;

          (e)  to reduce the authorized shares of any class pursuant to a 
               cancellation statement filed in accordance with (S) 9.05.

          (f)  to restate the articles of incorporation as currently amended.   
               ((S) 10.15)

NOTE 4:   All amendments not adopted under (S) 10.10 or (S) 10.15 require (1)
          that the board of directors adopt a resolution setting forth the
          proposed amendment and (2) that the shareholders approve the
          amendment.

          Shareholder approval may be (1) by vote at a shareholders' meeting
          (either annual or special) or (2) by consent, in writing, without a
          meeting.

          To be adopted, the amendment must receive the affirmative vote or
          consent of the holders of at least 2/3 of the outstanding shares
          entitled to vote on the amendment (but if class voting applies, then
          also at least a 2/3 vote within each class is required).

          The articles of incorporation may supercede the 2/3 vote requirement
          by specifying any smaller or larger vote requirement not less than a
          majority of the outstanding shares entitled to vote and not less than
          a majority within each class when class voting applies.    ((S) 10.20)

NOTE 5:   When shareholder approval is by consent, all shareholders must be
          given notice of the proposed amendment at least 5 days before the
          consent is signed. If the amendment is adopted, shareholders who have
          not signed the consent must be promptly notified of the passage of the
          amendment.                                       ((S)(S) 7.10 & 10.20)




 
                             File Number  4947-719-8
                                         -----------

                              STATE OF ILLINOIS
                                  OFFICE OF 
                            THE SECRETARY OF STATE
                            
                                    [LOGO]

WHEREAS, ARTICLES OF AMENDMENT TO THE ARTICLES OF INCORPORATION OF WEST SUBURBAN
KIDNEY CENTER, S.C. INCORPORATED UNDER THE LAWS OF THE STATE OF ILLINOIS HAVE
BEEN FILED IN THE OFFICE OF THE SECRETARY OF STATE AS PROVIDED BY THE BUSINESS
CORPORATION ACT OF ILLINOIS, IN FORCE JULY ,. A.D. 1984.


Now Therefore, I, George H. Ryan, Secretary of State of the State of Illinois,
by virtue of the powers vested in me by law, do hereby issue this certificate
and attach hereto a copy of the Application of the aforesaid corporation.

     IN TESTIMONY WHEREOF, I hereto set my hand and cause to be affixed the
Great Seal of the State of Illinois, at the City of Springfield, this 26th day
of April A.D. 1993 and of the Independence of the United States the two hundred
and 17th.

                                                      George H Ryan   
[SEAL]                                    -------------------------------------
                                                     SECRETARY OF STATE

 
 
                                                               
Form BOA-10.30                           ARTICLES OF AMENDMENT          File# D 4947-719-8

(Rev. Jan. 1991)
- ---------------------------------------------------------------------------------------------------------
George H. Ryan                                                            SUBMIT IN DUPLICATE      
                                                                    -------------------------------------
Secretary of State                                                                                 
Department of Business Services                                          This space for use by     
Springfield, IL 62756                                                      Secretary of State      
Telephone (217) 782-1832                                                                           
                                                                         Date 4-26-93              
- ----------------------------------------                                                           
                                                                         Franchise Tax      $      
Remit payment in check or money                                          Filing Fee         $ 25.00 
order, payable to "Secretary of State."                                  Penalty            $
                                                                         
                                                                         Approved: [SIGNATURE ILLEGIBLE]
- ---------------------------------------------------------------------------------------------------------
 

1.   CORPORATE NAME:  West Suburban Kidney Center, S.C.
                      ----------------------------------------------------------
                                                                        (Note 1)
2.   MANNER OF ADOPTION AND TEXT OF AMENDMENT:

          The following amendment of the Articles of Incorporation was adopted 
          on November 30, 1992 in the manner indicated below. ("X" one box only)

      [_] By a majority of the incorporators, provided no directors were named
          in the articles of incorporation and no directors have been elected;
          or by a majority of the board of directors, in accordance with Section
          10.10, the corporation having issued no shares as of the time of
          adoption of this amendment;
                                                                        (Note 2)

      [_] By a majority of the board of directors, in accordance with Section
          10.15, shares having been issued but shareholder action not being
          required for the adoption of the amendment;
                                                                        (Note 3)

      [_] By the shareholders, in accordance with Section 10.20, a resolution of
          the board of directors having been duly adopted and submitted to the
          shareholders. At a meeting of shareholders, not less than the minimum
          number of votes required by statute and by the articles of
          incorporation were voted in favor of the amendment;
                                                                        (Note 4)

      [_] By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          shareholders having not less than the minimum number of votes required
          by statute and by the articles of incorporation. Shareholders who have
          not consented in writing have been given notice in accordance with
          Section 7.10;
                                                                        (Note 4)

      [X] By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          all the shareholders entitled to vote on this amendment.
                                                                        (Note 4)

When amendment effects a name change, insert the new corporate name below. Use 
Page 2 for all other amendments.

Article 1: The name of the corporation is:

                                                                           3x
- --------------------------------------------------------------------------------
                                  (NEW NAME)


                All changes other than name, include on page 2
                                    (over)

 
                               TEXT OF AMENDMENT

    (Any article being amended is required to be set forth in its entirety)

     RESOLVED, that paragraph 1 of Article V of the Articles of Incorporation of
this corporation is hereby changed and amended to read as follows:

PARAGRAPH 1: The aggregate number of shares which the corporation is authorized 
to issue is 15,010,000 divided into two (2) classes. The designation of each 
class, the number of shares of each class, and the par value, if any, of the 
shares of each class, or a statement that the shares of any class are without 
par value, are as follows:

 
 
                                                PAR VALUE PER SHARE OR
                 SERIES         NUMBER           STATEMENT THAT SHARES 
   CLASS        (if any)       OF SHARES         ARE WITHOUT PARE VALUE
- ----------     ----------    -------------     --------------------------
                                       
COMMON            NONE           10,000         $1.00 par value per share

CLASS A
PREFERRED         NONE       15,000,000         $1.00 par value per share
 


 
3.   The manner in which any exchange, reclassification or cancellation of
     issued shares, or a reduction of the number of authorized shares of any
     class below the number of issued shares of that class, provided for or
     effected by this amendment, is as follows: (if not applicable, insert "No
     change")

     No Change

4.   (a) The manner in which said amendment effects a change in the amount of
     paid-in capital (Paid-in capital replaces the terms Stated Capital and 
     Paid-in Surplus and is equal to the total of these accounts) is as follows:
     (if not applicable, insert "No change")

     No Change

     (b) The amount of paid-in capital (Paid-in Capital replaces the terms
     Stated Capital and Paid-in Surplus and is equal to the total of these
     accounts) as changed by this amendment is as follows: (If not applicable,
     insert "No change")

     No Change

                                           Before Amendment    After Amendment

                    Paid-in Capital        $_______________    $______________

                      (Complete either Item 5 or 6 below)

5.   The undersigned corporation has caused this statement to be signed by its
     duly authorized officers, each of whom affirms, under penalties of perjury,
     that the facts stated herein are true.

     Dated   November  30              1992    WEST SUBURBAN KIDNEY CENTER, S.C.
           ---------------------------,  ----- ---------------------------------
                                                    (Exact Name of Corporation) 
                                           
     attested by (pb) /s/ Paul Balter          by (amm) Arthur M. Morris
                ------------------------------   -------------------------------
                 (Signature of Secretary or        (Signature of President or 
                  Assistant Secretary)              Vice President)

                 Paul Balter, M.D., Secretary  Arthur M. Morris, M.D., President
                ------------------------------ ---------------------------------
                (Type or Print Name and Title)   (Type or Print Name and Title)


6.   If amendment is authorized by the incorporators, the incorporators must
     sign below.
                                                 
                                      OR

     If amendment is authorized by the directors and there are no officers, then
     a majority of the directors or such directors as may be designated by the
     board, must sign below.
     
     The undersigned affirms, under the penalities of perjury, that the facts
     stated herein are true.

     Dated _______________________, 19__      
   
     ___________________________________      __________________________________

     ___________________________________      __________________________________

     ___________________________________      __________________________________

     ___________________________________      __________________________________

 
                            NOTES AND INSTRUCTIONS

NOTE 1:   State the true exact corporate name as it appears on the records of
          the office of the Secretary of State, BEFORE any amendments herein
          reported.

NOTE 2:   Incorporators are permitted to adopt amendments ONLY before any shares
          have been issued and before any directors have been named or 
          elected.                                                   ((S) 10.10)

NOTE 3:   Directors may adopt amendments without shareholder approval in only 
          six instances, as follows:

          (a)  to remove the names and addresses of directors named in the 
               articles of incorporation;

          (b)  to remove the name and address of the initial registered agent
               and registered office, provided a statement pursuant to (S) 5.10
               is also filed;

          (c)  to split the issued whole shares and unissued authorized shares
               by multiplying them by a whole number, so long as no class or
               series is adversely affected thereby;

          (d)  to change the corporate name by substituting the word
               "corporation", "incorporated", "company", "limited", or the
               abbreviation "corp.", "inc.", "co.", or "ltd." for a similar word
               or abbreviation in the name, or by adding a geographical
               attribution to the name;

          (e)  to reduce the authorized shares of any class pursuant to a 
               cancellation statement filed in acccordance with (S) 9.05.

          (f)  to restate the articles of incorporation as currently amended.   
                                                                     ((S) 10.15)

NOTE 4:   All amendments not adopted under (S) 10.10 or (S) 10.15 require (1) 
          that the board of directors adopt a resolution setting forth the
          proposed amendment and (2) that the shareholders approve the 
          amendment.

          Shareholder approval may be (1) by vote at a shareholders' meeting 
          (either annual or special) or (2) by consent, in writing, without a 
          meeting.

          To be adopted, the amendment must receive the affirmative vote or
          consent of the holders of at least 2/3 of the outstanding shares
          entitled to vote on the amendment (but if class voting applies, then
          also at least 2/3 vote within each class is required).

          The articles of incorporation may supercede the 2/3 vote requirement
          by specifying any smaller or larger vote requirement not less than a
          majority of the outstanding shares entitled to vote and not less than
          a majority within each class when class voting applies. ((S) 10.20)

NOTE 5:   When shareholder approval is by consent, all shareholders must be
          given notice of the proposed amendment at least 5 days before the
          consent is signed. If the amendment is adopted, shareholders who have
          not signed the consent must be promptly notified of the passage of the
          amendment.                                       ((S)(S) 7.10 & 10.20)

          The filing fee for articles of amendment - $25.00
          The filing fee for restated articles - $100.00.









 
                               STATE OF ILLINOIS
                                   Office of
                            The Secretary of State


Whereas, ARTICLES OF AMENDMENT TO THE ARTICLES OF INCORPORATION OF WEST SUBURBAN
KIDNEY CENTER, S.C. INCORPORATED UNDER THE LAWS OF THE STATE OF ILLINOIS HAVE
BEEN FILED IN THE OFFICE OF THE SECRETARY OF STATE AS PROVIDED BY THE BUSINESS
CORPORATION ACT OF ILLINOIS, IN FORCE JULY 1, A.D. 1984.


Now Therefore, I, George H. Ryan, Secretary of State of the State of Illinois,
by virtue of the powers vested in me by law, do hereby issue this certificate
and attach hereto a copy of the Application of the aforesaid corporation.

     In Testimony Whereof, I hereto set my hand and cause to be affixed the
Great Seal of the State of Illinois, at the City of Springfield, this 11TH day
of APRIL A.D. 1996 and of the Independence of the United States the two hundred
and 20TH.


                                                  /s/ George H. Ryan
                                                  -------------------------- 
                                                      Secretary of State

[SEAL]

 
Form BCA-10.30            ARTICLES OF AMENDENT      
(Rev. Jan. 1995                                            File # 4947-719-8
- --------------------------------------------------------------------------------
George H Ryan                                              SUBMIT IN DUPLICATE
Secretary of State
Department of Business Servics         FILED               This space for use by
Springfield, IL 62756                                      Secretary of State
Telephone (217) 782-1832            April 11 1996          Date 04-11-96
- -------------------------------
Remit payment in check or money                            Franchise Tax  $
order, payable to "Secretary         George  H. Ryan       Filing Fee*    $25.00
of State."                          Secretary of State     Penalty        $

*The filing fee for articles of 
amendment. $25.00                                          Approved:
- --------------------------------------------------------------------------------

1.   CORPORATE NAME:  West Suburban Kidney Center, S.C.
                    ------------------------------------------------------------
                                                                   (Note 1)

2.   MANNER OF ADOPTION OF AMENDMENT:

          The following amendment of the Articles of Incorporation was adopted 
          on 10-1-1995 in the manner indicated below. ("X" one box only)

     [_]  By a majority of the incorporators, provided no directors were named 
          in the articles of incorporation and no directors have been elected;

                                                                   (Note 2)

     [_]  By a majority of the board of directors, in accordance with Section
          10.10, the corporation having issued no shares as of the time of
          adoption of this amendment;

                                                                   (Note 2)

     [_]  By a majority of the board of directors, in accordance with Section
          10.15, shares having been issued but shareholder action not being
          required for adoption of the amendment;

                                                                   (Note 3)

     [_]  By the shareholders, in accordance with Section 10.20, a resolution of
          the board of directors having been duly adopted and submitted to the
          shareholders. At a meeting of shareholders, not less than the minimum
          number of votes required by statue and by the articles of
          incorporation were voted in favor of the amendment;

                                                                   (Note 4)

     [_]  By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of the directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          shareholders having not less than the minimum number of votes required
          by statue and by the articles of incorporation. Shareholders who have
          not consented in writing have been given notice in accordance with
          Section 7.10;

                                                                   (Note 4 & 5)

     [x]  By the shareholders, in accordance with Sections 10.20 and 7.10, a
          resolution of the board of directors having been duly adopted and
          submitted to the shareholders. A consent in writing has been signed by
          all the shareholders entitled to vote on this amendment.

3.   TEXT OF AMENDMENT:
     
     a.   When amendment effects a name change, insert the new corporate name 
          below. Use Page 2 for all other amendments.

          Article 1: The Name of the corporation is:

                         WSKC Dialysis Services, Inc.
- --------------------------------------------------------------------------------
                                  (NEW NAME)

              All changes other than the name, include on page 2 
                                    (over)


 
                               TEXT OF AMENDMENT

 b.  (if amendment affects the corporate purpose, the amended purpose is
     required to be set forth in its entirety. If there is not sufficient space
     to do so, add one or more sheets of this size.)

   RESOLVED, that Article Four of the Corporation's Articles of Incorporation is
   hereby amended to read as follows:

   "The purpose or purposes for which the corporation is organized are:

   Maintain and conduct any and every kind of sales, distribution, leasing,
   investment, and service business; to manufacture, process, fabricate,
   rebuild, service, invest in, purchase, sell, lease or otherwise dispose of
   and generally deal in and with raw materials, products, wares, goods,
   merchandise and real and personal property, both tangible and intangible, of
   every kind and description; to make investments of every kind and nature; and
   to provide services of every kind and character. To acquire, own, use, convey
   and otherwise dispose of and deal in real property.

   The corporation elects to be governed by the Business Corporation Act and 
   will not engage in the practice of medicine.

                                    Page 2

 
4.        The manner, if not set forth in Article 3b, in which any exchange,
          reclassification or cancellation of issued shares, or a reduction of
          the number of authorized shares of any class below the number of
          issued shares of that class, provided for or effected by this
          amendment, is as follows: (If not applicable, insert "No change")

          No Change

5.        (a) The manner, if not set forth in Article 3b, in which said
          amendment effects a change in the amount of paid-in capital (Paid-in
          capital replaces the terms Stated Capital and Paid-in Surplus and is
          equal to the total of these accounts) is as follows: (If not
          applicable, insert "No change")

          No Change

          (b) The amount of paid-in capital (Paid-in Capital replaces the terms
          Stated Capital and Paid-in Surplus and is equal to the total of these
          accounts) as changed by this amendment is as follows: (If not
          applicable, insert "No change")

          No Change

                                            Before Amendment   After Amendment

                        Paid-in Capital     $____________   $_____________

               (Complete either item 6 or 7 below. All signatures must be in 
               BLACK INK.)
               ---------

6.   The undersigned corporation has caused this statement to be signed by its
     duly authorized officers, each of whom affirms, under penalties of perjury,
     that the facts stated herein are true.

     Dated    October 1, 1995                WEST SUBURBAN KIDNEY CENTER, S.C.
           ------------- ----              -----------------------------------
                                             (Exact Name of Corporation at date 
                                              of execution)

     attested by  /s/ Paul Balter          by /s/ Arthur M. Morris
                 ------------------------    ---------------------------------
                 (Signature of Secretary         (Signature of President or  
                 or Assistant Secretary)          Vice President)

              Paul Balter, M.D., Secretary    Arthur M. Morris, M.D., President
              ----------------------------  -----------------------------------
                   (Type or Print Name and       (Type or Print Name and 
                    Title)                          Title)

7.   If amendment is authorized pursuant to Section 10.10 by the incorporators, 
     the incorporators must sign below, and type or print name and title.

                                      OR

     If amendment is authorized by the directors pursuant to Section 10.10 and
     there are no officers, then a majority of the directors or such directors
     as may be designated by the board, must sign below, and type or print name
     and title.

     The undersigned affirms, under the penalties of perjury, that the facts 
     stated herein are true.

     Dated__________________________, 19__
     _____________________________________   ___________________________________
     _____________________________________   ___________________________________
     _____________________________________   ___________________________________
     _____________________________________   ___________________________________

                                    Page 3


 
                            NOTES and INSTRUCTIONS

NOTE 1:   State the true exact corporate name as it appears on the records of
          the office of the Secretary of State, BEFORE any amendments herein
          reported.

NOTE 2:   Incorporators are permitted to adopt amendments ONLY before any shares
          have been issued and before any directors have been named or elected.
                                                                      ((S)10.10)

NOTE 3:   Directors may adopt amendments without shareholder approval in only 
          seven instances, as follows:
          (a)  to remove the names and addresses of directors named in the 
               articles of incorporation;
          (b)  to remove the name and address of the initial registered agent
               and registered office, provided a statement pursuant to (S) 5.10
               is also filed;
          (c)  to increase, decrease, create or eliminate the par value of the
               shares of any class, so long as no class or series of shares is
               adversely affected.
          (d)  to split the issued whole shares and unissued authorized shares
               by multiplying them by a whole number, so long as no class or
               series is adversely affected thereby;
          (e)  to change the corporate name by substituting the word
               "corporation", "incorporated", "company", "limited", or the
               abbreviation "corp", "inc", "co", or "ltd", for a similar word or
               abbreviation in the name , or by adding a geographical
               attribution to the name;
          (f)  to reduce the authorized shares of any class pursuant to a 
               cancellation statement filed in accordance with (S) 9.05,
          (g)  to restate the articles of incorporation as currently amended.
                                                                     ((S) 10.15)

NOTE 4:   All amendments not adopted under (S) 10.10 or (S) 10.15 require (1)
          that the board of directors adopt a resolution setting forth the
          proposed amendment and (2) that the shareholders approve the
          amendment.

          Shareholder approval may be (1) by vote at a shareholder's meeting
          (either annual or special) or (2) by consent, in writing, without a
          meeting.

          To be adopted, the amendment must receive the affirmative vote or
          consent of the holders of at least 2/3 of the outstanding shares
          entitled to vote on the amendment (but if class voting applies, then
          also at least a 2/3 vote within each class is required).

          The articles of incorporation may supersede the 2/3 vote requirement
          by specifying any smaller or larger vote requirement not less than a
          majority of the outstanding shares entitled to vote and not less than
          a majority within each class when class voting applies.    ((S)10.20)

NOTE 5:   When shareholder approval is by consent, all shareholders must be
          given notice of the proposed amendment at least 5 days before the
          consent is signed. If the amendment is adopted, shareholders who have
          not signed the consent must be promptly notified of the passage of the
          amendment.                                      ((S) (S) 7.10 & 10.20)

                                    Page 4






 
 
                                                 
PLEASE TYPE OR PRINT CLEARLY IN BLACK INK          FILING DEADLINE IS: PRIOR TO 03/01/91
                                                   ------------------

   RETURN TO:                                STATE OF ILLINOIS                 CORPORATION
Department of Business Services         DOMESTIC CORPORATION ANNUAL REPORT      FILE NO.    
Secretary of State                                                             D 4947-719-8
Springfield IL. 62756                                                          
Telephone (217) 782-7808                    YEAR OF 1991
 

1.)
    CORPORATE NAME                  WEST SUBURBAN KIDNEY CENTER, S.C.
    REGISTERED AGENT                C/O ALLAN S FINGER                 062686
    REGISTERED OFFICE               30 N LASALLE STREET                COOK
    CITY, IL, ZIP CODE              CHICAGO, IL. 60602-2502

 
                                                                      
                                                                       2.) AGENT/OFFICE CHANGES ONLY (see 11h)
3.) Date Incorporated 03/31/1969                                              WEST SUBURBAN KIDNEY CENT
                                                                              ----------------------------------
                                                                                   Corporation Name

    Give complete address of principal office, if other than above:           David J. Hochman
                                                                              ----------------------------------
    101 N. Scoville                                                                 Registered Agent
    
    Oak Park, IL 60302                                                        30 N LaSalle Street
                                                                              ----------------------------------
                                                                              Registered Office - Street Address

    Federal Employer identification Number                                    Chicago, Cook, IL 60602-2502
                                                                              ----------------------------------
    (FEIN)  * 362668594                                                       City, County, IL Zip Code
 

4.) The names and addresses of the officers and directors are: (if officers are
    directors, so state.)

 
 
             NAME                    OFFICE                NUMBER & STREET          CITY          STATE          ZIP
- ----------------------------------------------------------------------------------------------------------------------------- 
                                                                                                    
  Arthur M. Morris                  President              101 N SCOVILLE, OAK PARK, IL 60301
- ----------------------------------------------------------------------------------------------------------------------------- 
  Paul Balter                       Secretary                          "
- ----------------------------------------------------------------------------------------------------------------------------- 
  Paul Balter                       Treasurer                          "
- ----------------------------------------------------------------------------------------------------------------------------- 
                                     Director              SEE ATTACHED SCHEDULE FOR DIRECTORS
- ----------------------------------------------------------------------------------------------------------------------------- 
                                     Director        
- ----------------------------------------------------------------------------------------------------------------------------- 
                                     Director        
- ----------------------------------------------------------------------------------------------------------------------------- 
 

5.) The type of business actually conducted in Illinois is: to provide 
    professional medical services 

6.) Number of shares authorized and issued (as of 12/31/90)

 
 
CLASS                    SERIES                  PAR VALUE           NUMBER AUTHORIZED                  NUMBER ISSUED
- -----------------------------------------------------------------------------------------------------------------------------
                                                                                              
PAR STOCK                none                     $1.00                    10000                              1,200
- -----------------------------------------------------------------------------------------------------------------------------

- -----------------------------------------------------------------------------------------------------------------------------

- -----------------------------------------------------------------------------------------------------------------------------

7a.) The amount of paid-in capital as of 12/31/90                    7b.) The Paid-in Capital as of 12/31/90
                                   is:                                    on record with the Secretary of State is:
     *PAID-IN CAPITAL  $1,200,00                                          TOTAL $1,200          
                      --------------                                           -----------
     ** "Paid-in Capital" replaces the terms                              (The figure in item 7b may not be altered.)
       Stated Capital and Paid-in Surplus            
       It does not include Retained Earnings.

====================================================================================================================================
                                                       ITEM 8 MUST BE SIGNED

                                                                   Under the penalty of perjury and as an authorized officer,
                                                                   I declare that this annual report and, if applicable, the 
                                                                   statement of change of registered agent and/or office, 
                                                                   pursuant to provisions of the Business Corporation Act,
                                                                   has been examined by me and is, to the best of my know-
8.) By (amm) /s/ Arthur M. Morris              Pres   2/5/91       ledge and belief, true, correct, and complete.
       -----------------------------------------------------
       (Any Authorized Officer's Signature)   (Title) (Date)

====================================================================================================================================